Few effective treatments for chronic Keshan disease have been available till now.The efficacy of long-term selenium supplementation in the treatment of chronic Keshan disease with congestive heart failure is inconclusive.This study aimed to determine whether selenium supplementation is associated with a decreased risk of cardiac death in chronic Keshan disease with congestive heart failure by ten years of follow-up.A retrospective long-term follow-up analysis was performed on a monitored cohort consisting of 302 chronic Keshan disease patients with a mean age of 40.8±11.4 years.Of the 302 chronic Keshan disease patients,170(56.3%)were given selenium supplementation until the end point of follow-up.Cox proportional hazards regression models were used to identify the independent predictors of cardiac events.Our results showed that during the follow-up,there were 101 deaths of patients with chronic Keshan disease in the selenium supplementation group(101/170,59.4%)and 98 in non-selenium supplementation group(98/132,74.2%).Multivariate analyses suggested that selenium supplementation was associated with a decreased risk of cardiac death(HR 0.39,95%CI 0.28-0.53)after adjustment for baseline age,sex,cigarette smoking,family history of Keshan disease,body mass index(BMI),heart rate,electrocardiogram(ECG)abnonnalities,blood pressure,initial cardiothoracic ratio,left ventricular可ection fractions(LVEF)and whole-blood selenium concentration.Our ten-year follow-up analysis indicated that selenium supplementation,specifically combined with the use of angiotensinconverting cnzyme inhibitor and beta blocker therapy,improved the survival of patients with chronic Keshan disease with congestive heart failure.BMI,selenium deficiency,male,combined ECG abnonnalities,LVEF,and fast heart rate increased the risk of cardiac events.
In this study, differentially expressed genes in peripheral blood from patients with Kashin-Beck disease and Keshan disease were compared to further investigate the etiology and pathogenesis of both diseases, which occur in a common endemic area of China. Twenty Kashin-Beck disease patients and 12 healthy controls, and 16 Keshan disease patients and 16 healthy controls, were grouped into four pairs. Patients and controls were selected from common endemic areas for the two diseases. Total RNA was isolated from peripheral blood mononuclear cells from all patients and controls, and gene expression profiles analyzed by oligonucleotide microarrays. Sixteen genes differentially expressed in both Kashin-Beck disease and Keshan disease (versus controls) were identified, and comprised nine genes showing synchronous and seven asynchronous expression. The Comparative Toxicogenomics Database shows that expression and biological function of these genes can be affected by multiple environmental factors, including mycotoxin and selenium content, potential environmental risk factors for the two diseases. Thus, these shared differentially expressed genes may contribute to the distinct organ lesions, caused by common environmental risk factors of Kashin-Beck disease and Keshan disease.
